Healing Colombia’s Scars of War

WHY YOU SHOULD CARE

There’s no easy solution to mass trauma, but Colombia’s approach to recovering from a 50-year civil war could provide lessons.

November 21, 2014

Eight years ago, around 1 in the morning, Colombian Edgar Bermudez woke to grenades raining down on him and his battalion. He and his men — on a mission to eradicate coca in the jungles of southwestern Colombia — had come under attack by the Revolutionary Armed Forces of Colombia (FARC), a Marxist rebel group at war with the Colombian state since 1964.

Bermudez nearly made it through the six-hour bombardment unharmed, but then came the explosion. The 26-year-old felt the blast knock him to the ground. It cracked open his face and blew out his eyes. He’d be added to the list of 500,000 victims from the country’s armed conflict. Another 5.5 million people have been displaced, according to professor Andrés Moya, a Colombian behavioral economist. Some 220,000 have died. It took Bermudez months of physical rehabilitation and multiple surgeries; he learned braille. Yet the psychological toll would make for a completely different challenge. “I would wake up yelling and screaming,” he says. “And I still have nightmares today.”

Colombia is starting to face up to the psychological scars left on potentially hundreds of thousands of victims.

Negotiations to end Colombia’s civil war were suspended this week following the apparent kidnapping of an army general. Even so, the FARC has been beaten back over the past 10 years, and Colombia is starting to face up to the psychological scars left on potentially hundreds of thousands of victims. And it’s trying a homegrown, community-based approach that, among things, looks at the scars as a normal reaction to an abnormal situation, rather than as a pathology.

It’s a monumental challenge. If Colombia’s peace talks in Havana resume and succeed, it could mean bringing some 8,000 demobilized guerrillas into society. It also means addressing widespread suffering in the countryside. Doctors Without Borders, which has carried out mental health treatment for victims in Colombia’s conflict-torn Caquetá department, explains that its patients report suffering related to everything from conflict in the family, abuse and neglect to major depressive disorders.

The community gets to diagnose — in their own words — their own psychosocial pain.

Colombia is also learning from neighboring Peru what not to do. Professional psychologists diagnosed with post-traumatic stress disorder indigenous communities that had suffered from the country’s conflict with Marxist Shining Path guerrillas. But the approach of labeling a community as clinically ill met resistance because certain communities — like this group of indigenous Quechua women — were unresponsive to mental health treatments and interventions that fit an industrialized Western paradigm.

Soldiers and emergency workers at the site of an explosion: the police barracks in Inza, Colombia

Colombia’s Victims’ Unit is trying a strategy called Entrelazando. And it’s not called therapy. Entrelazando literally translates to “weaving together.”Members of the Victims’ Unit enter conflict-torn communities and try to identify group leaders, who are then activated to lead community rehabilitation. They intentionally steer away from clinical language (like therapy and PTSD) associated with sickness. Weavers act as emotional caretakers. Candidates can be grandfathers or grandmothers, a local folk singer in a Caribbean coast community, even an Amazonian woman who knows how to cure snakebites — anyone accustomed to caring in the community.

“The community gets to diagnose — in their own words — their own psychosocial pain,” says a member of the psychosocial team at Colombia’s Victims’ Unit, who asked not to be named in order to protect the privacy of victims. The approach borrows a concept developed by Spanish Jesuit priest Ignacio Martín-Baró. After working in marginalized communities across Latin America and earning a Ph.D. at the University of Chicago, Martín-Baró took his philosophy and his practice to El Salvador just as it plunged into civil war. Martín-Baró believed that trauma is a normal response to an abnormal situation — an idea that Colombia believes could work in some trauma-stricken communities.

Between 15 and 20 weavers are chosen from each community. They receive an orientation from a group of psychologists, social workers, sociologists, anthropologists and other professionals. Then the weavers are introduced to their communities again as leaders. “The new thing here is that we’re making it so communities don’t develop an unhealthy sense of dependence with the professional,” says the member of Colombia’s Victims’ Unit. “The idea is to develop a strong sense of autonomy.” The people behind Entrelazando say their approach is being carried out across the country in more than 100 communities affected by violence related to the armed conflict.

“The fact that Entrelazando exists is good news,” says Moya. “Some cases in Africa — especially where there’ve been genocides and civil wars — show that community therapy practices can be effective in making people feel like what happened was not their fault and lets them identify with others who had similar experiences.” But Moya warns that Entrelazando isn’t enough. Entrelazando, he points out, is helping around 30,000 victims, “but Colombia has 6 million victims. So the question is, how do you get to all those other victims?” Moya says that victims also need economic opportunities, a concrete path to create socioeconomic stability, or else more stress could lie ahead. Building peace, says Moya, could take a decade.

Bermudez knows that his fateful day in combat with the FARC eight years ago has left him with clinical PTSD. The blind man insists Colombia has to recognize that some victims need professional help. But he also believes that to possess the lasting label of “victim” suggests that someone is sick, incapacitated … without hope.

“I’m a survivor,” says Bermudez. “And a survivor is someone who has held on and overcome pain — someone who is looking to the future …”